hi, dolphyrn, and welcome to allnurses!
all care planning is problem solving. we use the nursing process to problem solve. there are 5 steps to the nursing process and the first three are critical in starting the care plan:
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
- planning (write measurable goals/outcomes and nursing interventions)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)
the first thing you need to do is what step #1 tells you: assessment
. these things are very specific to nursing assessment:
- a physical assessment of the patient
- assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease; the adls include bathing, dressing, mobility, eating, toileting, and grooming; you would evaluate how individuals function within their homes, workplaces, and social environments
- data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
- knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
- you can find lots of weblinks to information about medical diseases and their treatment on this sticky thread in the nursing student assistance forum: http://allnurses.com/forums/f205/med...es-258109.html - medical disease information/treatment/procedures/test reference websites
- periodic paralysis
- http://www.medicinenet.com/low_potas...ia/article.htm - low potassium (hypokalemia) symptoms: muscle weakness, muscle aches, and muscle cramps. diagnosis: blood tests and electrocardiogram. treatment: potassium replacement
- http://www.merck.com/mmpe/sec12/ch15...156-ch156f-779 - "hypokalemia is serum k concentration < 3.5 meq/l caused by a deficit in total body k stores or abnormal movement of k into cells. the most common causes are excess losses from the kidneys or gi tract. clinical features include muscle weakness and polyuria; cardiac hyperexcitability may occur with severe hypokalemia. diagnosis is by serum measurement. treatment is administration of k and addressing the cause." the pathophysiology follows.
- from my own files:
- lab values of potassium:
- normal adult:
- 3.5-5.0 meq/liter
- 3.5-5.0 mmol/liter
- normal child:
- 3.4-4.7 meq/liter
- 3.4-4.7 mmol/liter
- normal urine in adult:
- 26-123 meq/24 hrs
- 26-123 mmol/24 hrs
- panic (critical) values:
- below 2.5 meq/liter
- above 6.5 meq/liter
- symptoms of hypokalemia
- shallow respirations
- arrhythmias with ekg changes: st segment depression, flattened t waves, prominent u waves
- ventricular arrhythmias
- thready pulse
- cardiac arrest
- decreased contractility of smooth, skeletal and cardiac muscles
- decreased peristalsis
- abdominal distention
- decreased bowel (intestinal) motility/intestinal ileus
- muscle weakness
- muscle cramps
- weakness initially in the legs, particularly the quadriceps, then in the arms followed by involvement of the respiratory muscles
- dilute urine
- polydipsia (thirst)
- leg cramps
- cardiac arrest
- foods high in potassium:
- dried beans
- lima beans
- apricots (raw)
- peaches (raw)
- pears (raw)
- apricots (dried)
- orange juice
it is important that after doing all this research that you match what you have found against what you observed in your patient. why? because as a student you don't always see what is in front of you when you are with a patient. this is how you will learn. this is how you will remember to assess the next patient you have with the same or similar condition. with periodic paralysis you want to know what brings on the attacks of weakness so you can develop nursing interventions to help the patient either prevent them from happening or how to treat them.
after finding all that information, you are ready to move on to the next step in care planning--determining the patient's problems and nursing diagnoses
. to do this you need to make a list of all the abnormal information you observed in the patient. this abnormal information, or you could call them symptoms, are the evidence (proof) that supports the nursing problems that you must figure out they fit with. every nursing diagnosis (nursing problem) has a defined list called defining characteristics by nanda, the north american nursing diagnosis association, that identifies what that nursing problem consists of. your job is to figure out what nursing diagnosis your patient's abnormal data belong with.
once you have done that you can move on to the third step which is the caregiving part of the care plan--writing goals/outcomes and nursing interventions.
both of these are based upon that abnormal data that you found and collected during your assessment of the patient and that you use to support the various nursing diagnoses that you chose.
as you can see, what you do during your assessment activity is extremely
important to what goes into your care planning. knowing that the patient has hypokalemia and, specifically, periodic paralysis because of hypokalemia is only a beginning. do you see all the information i began to generate from those two pieces of information? and, i didn't even get into the actual choice of any nursing diagnoses, goals or nursing interventions! i'll leave that to you. i've given you a good start in the right direction. let's see what you can do with this.